Group blog on success, doing well and being well.
Posts address different aspects of success and the relationship between success and health, and reflect on successful interdisciplinary research collaborations.

She has directed lots of new and classic plays including: The Knowledge and Our New Girl (Bush Theatre), Benefactors (Sheffield Theatres), and The Uncertainty Project (Paines Plough).

She was Associate Director for the Bush Theatre, under Josie Rourke in 2006, and was awarded a Quercus award in 2014 by the National Theatre, as well becoming Associate Director for Liverpool Everyman and Playhouse. She is currently an Associate Director at Sheffield Theatres.

It is wonderful news that someone with Charlotte's experience and background is keen to collaborate on a project investigating success, especially as Charlotte herself is interested in the various aspects that make a play successful. Charlotte will help us convert some of our and her ideas on success in a play destined to young children.

I'm looking forward to discuss the details with Charlotte and the rest of the team in September!

Tuesday, 11 August 2015

Last week, at Wellcome Collection, I met with Helen Paris,who together with Leslie Hill form Curious. Curious have already created two artworks with the support of Wellcome Trust. One about ‘gut-feelings’ (The Moment I Saw You I Knew I Could Love You) was a collaboration with gastroenterologists at Barts, London. The other, about smell and memory (On The Scent), involved collaboration with a biologist at the National Centre for Biological Sciences, Bangalore, India.

Helen and I had a wide ranging conversation, but one element stuck in my mind – the possibility of failure and the opportunity to fail. Helen teaches performance at Stanford, USA. In one class she asks students to experience failure by creating ‘bad’ artworks. In order to succeed in the class they have to fail in their art, which Helen says the students find very confusing. What is the role of failure in success?

For artists, learning to take risks is necessary for success. Yet taking risks results in the possibility of failure. Drawing on Nietzsche', the early contemporary choreographer Doris Humphrey described how the modern dancers should always inhabit the ‘arc between two deaths’ - the moment of falling, between standing still and lying down. For Humphrey, lack of risk was the death of the artwork. If you were safely standing, or safely lying down, nothing interesting was happening. To dance, to create 'good' art, you must take the risk - and accept the possibility of failure.

But in healthcare, risk is unacceptable.

In a Lottery-funded project about interpersonal perspectives of suicidality, I was interested to hear service-user and family members discuss how while risk, and risk-assessment was very much part of many suicidal people’s lives, care and humanity was less evident. It seemed to many of our participants, that our risk-averse healthcare culture had reduced care to box-ticking, and that the humanity had all but disappeared. I am reminded of being told about an experience of being an inpatient (partly described in an article by Amy Woods & Neil Springham), when the service-user reported that hearing kind words from the ward cleaner was a standout moment of her mental health inpatient stay.

What is the relationship between risk and care? Trust seems important here, and was lacking for those participants who had been suicidal. I’m very interested in how trust manifests between people, rather than inhabiting any one person. It is neither a cognition, a behaviour nor a feeling, but perhaps a mixture of all these, happening across persons, not inside them - in a distributed way.

Helen Paris told me she thinks of trust in terms of an invitation – the invitation is given to the audience and she awaits the response. For example, in their recent piece Out of Water, Helen holds out her hand to an audience member, who is then led down to the edge of the sea. In making the invitation there is risk and vulnerability. How will the audience member respond? Helen says creating an atmosphere of trust and safety in the artwork is important.

There is risk and vulnerability in mental health care too. For service-users, who have perhaps been let down or hurt many times before, there is huge risk in approaching services for help, and allowing themselves to become vulnerable in the moment of trust. But for the staff too there is risk and vulnerability. (And I am thinking of my own experience here, as a trainee psychotherapist). If we make ourselves vulnerable by showing care for a service-user/client, what will happen? There is risk in creating attachments with the people we ‘care’ for (and this also goes for informal carers and wider friends and family of those with mental health problems). There is risk in acknowledging that as healthcare providers we often do not have adequate methods to ease suffering, and that we, sadly, sometimes fail to keep people safe or help them become well.

In thinking about success, failure, vulnerability and risk are all implicated. This seems to be the case in both artist endeavours and in healthcare.

Monday, 10 August 2015

Almost every week we read about the "unexpected benefits" of mental distress: people with depression are more accurate in their judgements, people with mania are more creative, people with anxiety are perfectionists. How should we interpret this literature, and is it a good thing to associate diagnostic labels to general patterns of behaviour that are viewed as positive?

Dianne Harris, Wellcome Images

This is a question I asked myself a lot recently, facing the reactions that my work on project PERFECT provokes in people with lived experience of mental distress, academics and the general public. PERFECT is about the potential benefits of imperfect cognitions (delusions, confabulations, distorted memories) and thus it often emphasises such benefits in the context of the behaviour of people with a psychiatric diagnosis.

One reaction is the Enthusiasts'. They believe it is wonderful to battle stigma by talking about people with mental distress in a more balanced way, highlighting the positives as well as acknowledging the negatives. The opposite reaction is the Sceptics'. They are wary of sweeping claims romanticising what by many is experienced as pain, distress, isolation, failure.

What should we think when we are told that anxiety makes us more successful performers and depression makes us more knowledgeable about ourselves? (Links are to popularised versions of these claims in the media, not to research articles in academic journals). I think we should first distinguish between the more and less severe form symptoms can take. A pinch of anxiety might make us more excited before an important performance, keeping us on edge and motivating us to prepare better. A depressive mood may be a powerful antidote to the overwhelming optimism we generally experience when we assess ourselves and our prospects. But crippling anxiety and major depressive episodes are no fun, and seem to deliver no benefits at all, rather than maybe develop resilience in the people who survive them.

This is a message we get clearly from the first-person accounts we publish in Imperfect Cognitions (see Emily Troscianko on anorexia): sadly, some situations have no silver-lining.

To explore these issues in the context of our interest in "striving and thriving" will help us map the relationship between mental health and success. This task will be partly empirical as it will require to collect information about how people behave and how their mental distress affects their behaviour, and partly conceptual as one will have to have a pretty good idea of what success entails in order to collect data that are relevant. Michael's last post helps with clarifying what the conceptual questions may be like: Is the successful person the one who finds meaning in what she does, or the one whose measurable achievements exceed expectations? Is there a notion of success that can capture both aspects?

I've just read "The Second Machine Age", by Brynjolfsson and McAfee, and I thought I would share some thoughts relevant to our project with you.

The authors explain the concept of a winner-take-all economy. This is an economy where the company or individual that produces the best product or the best performance gets huge rewards and all the competitors get relatively little, even when the quality of their product or performance is only slightly lower than the quality of the product or performance of the top company or individual. The authors also explain how technology (and digitisation in particular) and globalisation are pushing contemporary society more and more towards a winner-take-all economy.

Digitisation means that many goods (those that can be digitised) can be reproduced at a very low cost and can thereby invade global markets very easily. The same applies to goods that have a low marginal cost of reproduction. So, within any particular niche of the market, the best version of one product can generate huge profits for its producer leaving only crumbs to the producers of second-best versions. As the Nike ad put it "you don't win silver, you lose gold".

Winner-take-all systems for the distribution of rewards can be useful for some purposes: they can spur excellence and innovation (in some circumstances, when they don't give rise to monopolies, etc.) But they obviously result in huge inequalities. If there is no mechanism to redistribute the rewards of the winner so that the whole of society can benefit, the inequalities accumulate and become entrenched.

This is bad in all sorts of ways and for all sorts of things, including health. The epidemiological literature on the social determinants of health has shown how significant the impact of inequalities on health are. In the decades to come, the shift towards a winner-take-all economy generated by digitisation and globalisation will make those impacts even more significant and problematic than they already are.

Last night I braved the tube strike to visit the Wellcome Collection, and I spent some time in the Reading Room. I’ve always loved libraries and bookshops, so it’s perhaps no surprise that I feel very at home there, but there’s something more going on. Ever since early in this project I’ve become hooked on this idea of collections, archives, libraries – there’s something here for me, but what? I have proposed that as part of the project we create a digital archive of all the ‘Stories of Success’ we come across during our residency – these may be oral stories, videos, texts, or other media; drawings, photographs, objects etc. They may be collected from members of the public (perhaps with the help of storytellers, SparkLondon), from our empirical work, or from our collaborators themselves. But my interest in collection seems to even go beyond that.

Is it to do with memories? Helen Paris, from Curious, (see separate post to follow) told me about a collaborator of hers, a dancer, who made a piece about how our memories for places can be held in a bodily library. I’m interested in the intersection between bodily memory and narrative memory, and wrote about this in my PhD research on guilt. I know some of our collaborators will be working with dementia, and that Victoria has done a lot of work in this area, so there are links here. Perhaps memory and memorialising are becoming more important to me as I get older. Do I see this project as such a precious opportunity that it must not be forgotten? Am I keen to remember? And to ‘re-member’; to embody this conceptual work and make it real, tangible.

Is it about storage and legacy, or a need to create something tangible for posterity? Something that can be shared, and that can transcend time? Am I feeling the urge to hoard ideas, less then become suddenly scarce? Maybe I want to create a perfect collection, tracking down every possible variation until I have a complete set... I do feel that if we were given two years to explore success we should create something that endures; that has duration; that lasts beyond the two years. On Tuesday, Michael and I noticed that we need to think about the sustainability and the legacy of this project for the new application form – but it’s more than this. It feels almost like a moral responsibility or an compulsion for me. We (Michael and I) were discussing how having a significant piece (actually several linked pieces) of empirical work gives us a strong grounding for our work, from a disciplinary perspective, but will also provide us with material that we can revisit well beyond the life of this project. And that hopefully others in our group, and beyond, can explore too.

Or is this interest in collections actually more about multiplicity? This feels most likely. The reading room contains many different perspectives on mental health, for example, some from the service-user movement, some critical psychology, some mainstream, some from psychiatry etc. etc. Voices that wouldn’t normally be heard together. All these multiple voices are allowed to coexist in a library. In an exhibition (and also in the reading room), exhibits in different media are allowed to rest next to one another. Objects from different centuries, continents, peoples, and of different ‘values’ can sit together. The audience/reader/viewer is treated as an intelligent and curious individual who has the capacity to take on board multiple viewpoints and to stitch them together in their own, unique ways. It feels like there are increasingly few spaces in our world where such multiplicity is celebrated.

I think it is this – the multiplicity – that specifically interests me about the idea of collections, libraries and archives. Perhaps too often I surround myself with people who think like me – providing the familiar, the comfortable. In my discipline, my view of the world is fairly marginalised, so it’s perhaps no wonder that I find others like me, and we club together to create a safe ‘home’ for ourselves. However, this intellectual ghettoisation is very limiting. I feel more inspired by the conversations I’ve had with artists this summer, than by any journal article I’ve read. I’ve suddenly remembered how reading non-scientific literature, looking at artwork, and going to the theatre is more than just an enjoyable activity, but can feed directly into my research.

Perhaps with this project we can 1) create a collection of people. Perhaps this is the very special and unusual thing - a chance for people who wouldn’t normally share space to meet, talk and create. I strongly believe that if you put interesting people together in a room, interesting things will happen. Of course, we need some structure, outcomes and milestones, but we must allow for flexibility and spontaneity too. And so then 2), through cross-pollination, and sparking off each other, we can generate a collection of ideas. Maybe one equal to any library or museum collection.

Wednesday, 5 August 2015

I've been busy moving house this last few weeks, which has presented its own modest opportunities to 'thrive in the face of adversity.' Luckily for me, the adversity is only of the inconvenient and transitory form, but it has meant that I've felt a little out-of-step with our plans here this month.

Yesterday, Zoë and I had a day blocked out to catch up on this stuff, and alongside a lot of very practical planning stuff, we also managed to begin think through a few more interesting angles on the meaning of succeeding. One of these - which really resonated with me - was the observation that 'default,' everyday understandings of success are very often situated at one end of a polarity, with metrics and technique at one end of succeeding (how much money, how many skills, etc.) and meaning and content (defining success in our own terms, for its intrinsic value, or in terms of what it permits us to communicate).

I think this is brilliantly illustrated in these two contrasting clips from the BBC's 'Listening project.' In one, Miguel and John discuss the financial implications of their transition to what seems to be construed as a 'state of success' (albeit a vulnerable one).

In the other, which is misleadingly billed as the story of two musicians who have 'not known success,' Duncan and Paul describe how - on their own terms - they consider their musical work to have been rewarding and successful.

This led us to thinking about competency (artistic technique; professional skills in healthcare; leadership and its qualities; the collaborative 'joint action' aspect of skilled enactment; evidence-based training and change) as a dimension of success, and as one which links the interests of several of our proposed collaborators for the theme. I experience a bit of 'de-skilling' when I think about this. I find the topic fascinating, but will need to rely heavily on the expertise of collaborators in order to explore it meaningfully. It seems to be the nature of this scheme that its interdisciplinary and interconnected nature takes one seemlessly into the realms of topics which are *just outside* of one's comfort zone. I expect that this is a good thing, really, but it will be good to deal with this in a team context. A little bit of time and space for reflection goes a long towards coping with the twin perils of Discomfort and Complacency!

The other thing I wanted to post, because of Matteo's interests in Lord Owen's ideas about character, leadership and hubris, does link - tenuously perhaps - to this idea of knowing your limits, and extending them cautiously. David Owen gave a very interesting interview to Radio 4's Reflections programme, last week. I was struck by a few things: the non-partisan nature of his judgements about important people in his career; the strength of feeling still evident in Owen's account of his departure from the Labour party, and the difficulty that Owen had in responding to his interviewer's question about the consequences of that departure for his own political career.

I wonder if there is some merit in thinking about the motif of the 'road not taken,' in relation to the meaning of success. Thinking back to those two co-constructed narratives from the Listening Project, I notice that some of the more emotive content settles around the 'what if?' and 'if only?' moments. There's a sense of precariousness and transience to many of our experiences of 'doing well.'